Advertisement

Pediatric Radiology

, Volume 46, Issue 7, pp 1059–1067 | Cite as

Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections

  • Anjum N. BandarkarEmail author
  • Adebunmi O. Adeyiga
  • M. Taylor Fordham
  • Diego Preciado
  • Brian K. Reilly
Pictorial Essay

Abstract

Peritonsillar infections are one of the most common deep neck space infections, particularly in adolescents. Inaccurate diagnosis can lead to delay in management and potentially life-threatening complications. Contrast-enhanced computed tomography (CT) scan of the neck traditionally has been used to diagnose suspected peritonsillar abscess. With growing concern over radiation exposure, there has been increasing utilization of ultrasound (US) using intraoral and transcutaneous approaches. We chose the transcutaneous US technique due to its ease of performance in children. The purpose of this article is twofold: a) to describe our technique of performing transcutaneous US of the tonsil showing sonographic appearance of normal tonsil, highlighting pertinent anatomy and unique considerations for this modality in children, and b) to illustrate the sonographic findings in the spectrum of pediatric peritonsillar infections, which includes uncomplicated tonsillitis, peritonsillar cellulitis, small intratonsillar abscess and frank peritonsillar abscess. Parapharyngeal abscess can sometimes be detected.

Keywords

Abscess Children Infection Peritonsillar infection Tonsil Ultrasound 

Notes

Acknowledgments

We would like to express our sincere appreciation to our stellar sonographers - Cathy Brown Jones, Tara Cielma, Amanda George, Pamela Handelman, Megan Hartman, Danyelle Holley, Suella Jones, Kadine Linden, Linda Rebolo, Courtney Ruiz and Roza Zenelaj, for their expertise and insight. We are grateful to Dr. Asif Momin for his scientific guidance. We also thank Drs. Anna Blask and Eglal Shalaby-Rana for their critical comments.

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Steyer TE (2002) Peritonsillar abscess: diagnosis and treatment. Am Fam Physician 65:93–96PubMedGoogle Scholar
  2. 2.
    Millar KR, Johnson DW, Drummond D et al (2007) Suspected peritonsillar abscess in children. Pediatr Emerg Care 23:431–438CrossRefPubMedGoogle Scholar
  3. 3.
    Herzon FS, Nicklaus P (1996) Pediatric peritonsillar abscess: management guidelines. Curr Probl Pediatr 26:270–278PubMedGoogle Scholar
  4. 4.
    Buckley AR, Moss EH, Blokmanis A (1994) Diagnosis of peritonsillar abscess: value of intraoral sonography. AJR Am J Roentgenol 162:961–964CrossRefPubMedGoogle Scholar
  5. 5.
    Strong EB, Woodward PJ, Johnson LP (1996) Intraoral ultrasound evaluation of peritonsillar abscess. Laryngoscope 105:779–782CrossRefGoogle Scholar
  6. 6.
    Ahmed K, Jones AS, Shah K et al (1994) The role of ultrasound in the management of peritonsillar abscess. J Laryngol Otol 108:610–612CrossRefPubMedGoogle Scholar
  7. 7.
    Mettler FA Jr, Huda W, Yoshizumi TT et al (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248:254–263CrossRefPubMedGoogle Scholar
  8. 8.
    Scott PM, Loftus WK, Kew J et al (1999) Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis. J Laryngol Otol 113:229–232PubMedGoogle Scholar
  9. 9.
    Rehrer M, Mantuani D, Nagdev A (2013) Identification of peritonsillar abscess by transcutaneous cervical ultrasound. Am J Emerg Med 31:267.e1-3CrossRefPubMedGoogle Scholar
  10. 10.
    Lyon M, Glisson P, Blaivas M (2003) Bilateral peritonsillar abscess diagnosed on the basis of intraoral sonography. J Ultrasound Med 22:993–996PubMedGoogle Scholar
  11. 11.
    Powell J, Wilson JA (2012) An evidence-based review of peritonsillar abscess. Clin Otolaryngol 37:136–145CrossRefPubMedGoogle Scholar
  12. 12.
    Sakaguchi M, Sato S, Asawa S et al (1995) Computed tomographic findings in peritonsillar abscess and cellulitis. J Laryngol Otol 109:449–451CrossRefPubMedGoogle Scholar
  13. 13.
    Baker KA, Stuart J, Sykes KJ et al (2012) Use of computed tomography in the emergency department for the diagnosis of pediatric peritonsillar abscess. Pediatr Emerg Care 28:962–965CrossRefPubMedGoogle Scholar
  14. 14.
    Wald ER Peritonsillar cellulitis and abscess. In: UpToDate. Accessed 20 Jan 2014. Retrieved from http://www.uptodate.com/contents/peritonsillar-cellulitis-and-abscess
  15. 15.
    Ulualp SO, Koral K, Margraf L et al (2013) Management of intratonsillar abscess in children. Pediatr Int 55:455–460CrossRefPubMedGoogle Scholar
  16. 16.
    Fordham MT, Rock AN, Bandarkar A et al (2015) Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess. Laryngoscope. doi: 10.1002/lary.25354 Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Anjum N. Bandarkar
    • 1
    Email author
  • Adebunmi O. Adeyiga
    • 1
  • M. Taylor Fordham
    • 2
  • Diego Preciado
    • 3
  • Brian K. Reilly
    • 3
  1. 1.Division of Diagnostic Imaging and RadiologyChildren’s National Health SystemWashingtonUSA
  2. 2.Department of OtolaryngologyChildren’s Hospital of San AntonioSan AntonioUSA
  3. 3.Department of Pediatric OtolaryngologyChildren’s National Health SystemWashingtonUSA

Personalised recommendations